Approach to the adolescent interview
What are the 3 leading causes of death for adolescents in the US
HAS
- Homicide
- Accidents
- Suicide
What are the HEEADSSS questions used to survey your patients?
- Home
- Education/Employment
- Eating disorders
- Activities/Affiliations/Aspirations
- Drugs (including alcohol, tobacco, steroids)
- Sexuality
- Suicidal behavior
- Safety
What are the top 3 most abused substances in teenagers?
- Alcohol (71%)
- Marijuana (40%)
- Inhalants (11%)
- Cocaine (7%)
Information gathered from the Center for Disease Control and Prevention (CDC).
What name 3 substances that have adverse effects due to prenatal substance abuse.
TACo
- Tobacco
- increases low birth weight in fetus
- no characteristics associated with it
- Alcohol
- fetal alcohol syndrome (no safe amount)
- facial assoc: growth def and evidece of central nervous system dys.
- Cocaine and other
- causes vasoconstriction–> low birth weight & placental insufficency
What is the difference between SGA and IUGR?
- SGA: small for gestational age
- this is an overarching umberella
- diagnoses at birth
- due to contitutional factors determined by Maternal factors, fetal factors, Meds
- IUGR: Intrauterine growth restriction
- This is more of a specific theme/concept
*
- This is more of a specific theme/concept
What are 3 factors that limit fetal growth in utero?
- Maternal factors
- Placental abnormalities
- Fetal abnormalities
What 5 factors increase the risk of HIV transmission from mother to infant?
FAM VB
- Freq unprotected sex during prenancy
- Advanced maternal HIV disease (which may indicate viral load)
- Membrane rupture greater than 4 hours prior to delivery if mother is not an antiretroviral therapy
- Vaginal delivery
- Breastfeeding
What is an important factors in treating/preventing Perinatal group B streptococcal infections?
- IAP (intrapartum antibiotic prophylaxis is highly effective at preventing early onset GBS disease among infants born to colonized women.
What week range of gestation shoud all women undergo vaginalrectal screening for GBs colonization?
35-37 weeks of gestation
What should penicillin-allergic women with an indication for IAP receive?
cefazolin
- This drug is not established as effective at preventing early-onset GBS disease*
- it does not reach the fetal circulation or aminiotic fluid well, and an increaseing proportion of GBS isolates are resistant to it.*
What are 3 ways to go about decreasing the risk of vertical HIV transmission?
BC-Z
- Treatment: Zidovudine (decreases teh incidence of vertical HIV transmission.
- Cesarean delivery should be performed prior to the onset of labor and the rupture of membranes
- HIV infected women should be counseled not to breastfeed their infants.
What are 4 special features to do while performing newborn resuscitation?
- this is in addition to remebering the CABs*
- WISS*
- Warm and dry the infant and remove any wet linens immediately
- Stimulate the infant to elicit a vigorous cry
- Suction amniotic fluid from the infant’s nose and mouth
- Initiate further resuscitation if required.
What are the compeonets of the Apgar score?
- Appearance (skin color)
- Pulse (heart rate)
- Grimance (reflex irritability)
- Activity (muscle tone)
- Respiration
each child receives a score ranging from 0 to 10, we never give above a one on apperance so each baby gets an apgar score of 9/10 max.
When using the apgar score?
What can lower the score?
- Not used for
- predictor of neurologic developement
- id-ing cosngenital anomalie
- lowering score
- preterm birth
- drugs
Define the ballard gestational age assessment tool
- uses signs of physical and neuromuscluar maturity to estimate gestational age
- this is helpful if no early prenatal ultrasound to help confirm dates, or if teh gestational age is in question because of uncertain maternal dates.
What is the scoring system of Ballard maturation assessment of gestational age?
- score 0= 24 weeks
- every 5 points you go up around 2 weeks
- e.g. 5=26, 10=28, 15=30, 20=32, etc. etc. etc.
Whats the difference b/t symmetric vs asymmetric IUGR?
- Symmetric: IUGR refers to a growth pattern in which both head and abdomen are decreased proportionately.
- Asymmetric: IUGR refers to a greater decrease in the size of the abdomen than that of the head (head-sparing phenomenon)
What are the 3 things SGA infants are at risk for?
Hypo, poly, hypo
- Hypoglycemia
- Hypothermeia
- Polycythemia
Identify primitive reflexes in an infant?
Root- PASSS
- Rooting
- Palmar and plantar grasp
- Asymmetrical tonic neck response
- Sucking
- Startle (Moro)
- Stepping response
